Critical Levels

On this month’s episode, we’re joined by Dr. Bonnie Snyder to discuss BVM as well her recently published paper in Resuscitation: Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. During the episode, you’ll hear us cover: There is nothing basic about the BVM - it is not a benign intervention Rate and volume based on the guidelines General airway management BVM sizing Dr. Snyder’s study

On this month’s episode, we’re joined by Dr. Janice Tijssen to discuss pediatric cardiac arrest. During the episode, you’ll hear us cover: The importance of our early interventions What is cardiac arrest Differences between adult and pediatric cardiac arrest Simplifying our response Symptomatic bradycardia The importance of scene time The importance of CPR/ventilation IV vs IO, SGA vs ETT Epinephrine PRIME study Family presence during arrest Disposition

On this month’s episode, we’re joined by Dr. Louisa Marion-Bellemare to discuss Suboxone (buprenorphine/naloxone) and managing patients who use illicit and controlled drugs. During the episode, you’ll hear us cover:

On this month's episode, we chat with Matt Smith about wilderness medicine. As we shift from a high resource to a low resource setting, there are 3 main concepts to consider: - Ideal to real - High risk to low risk - Stable to unstable These concepts are important as we shift our practice and prepare ourselves. For this patient context, we need to focus on the things we can't replace, and learn to manage that. Our approach to these patients need to be algorithmic, and focus on doing the basics well. Two mnemonics (H-E-M-P; A-B-C-D-E) are presented to help with our approach. Lastly, hypothermia assessment and management is discussed.

On this month’s episode, we discuss acute coronary syndrome (ACS) with Dr. Jess McLaren We define ACS, we cover pathophysiology, and some common causes. Importantly we discuss the assessment of this patient population - paying attending to both objective and subjectives signs and symptoms. We spend some time talking about electrocardiograms, and perhaps most importantly, we chat about the management of this patient.

On this episode, we’re joined by Dr. James Gilbertson with the Ottawa Hospital, and Cst. Caroline Gallant with The Ottawa Police Marine, Dive and Trails (MDT) Unit. We take a dive into drowning and cover: Lastly, we speak to drowning prevention

In British Columbia 7 people per day are dying as a result of a highly contaminated toxic supply of drugs. Since the announcement of the public health crisis related to illicit drug toxicity deaths in 2016 over 12,000 people have lost their lives. Despite previous misconceptions that the toxic drug crisis is confined to Vancouver’s lower mainland and the downtown east side, Jen is sounding the alarm that not a square inch of the province of BC has been unaffected by the crisis. Working on the frontlines of a provincial organization means every patient and every paramedic is being affected, and as a service provider the organization is burdened with the monumental task of meeting the demand for emergency health services in rural communities that otherwise have never required such a response. Jen emphasizes the importance of the paramedic role given the frequency at which they interact with people who use drugs. She proffers that paramedics are uniquely positioned to offer alternative models of care that aim to reduce harm, but that the window of opportunity to offer these tools is narrowing. In this episode Jen speaks to some of the things paramedics can be doing to reduce harm in their approach, and in pathways that their organizations can be offering to patients. You can learn more about what the literature is saying about the paramedic role in caring for people who use drugs in Jen’s scoping review. You can contact Jen on twitter at @jlynnbolster or e-mail her directly at jennifer.bolster@bcehs.ca

“No statistical difference” On today’s episode of Critical Levels, we chat with Dr. Ken Milne of the Skeptics’ Guide to Emergency Medicine (https://thesgem.com; @thesgem). We start with a high-level discussion and literature and evidence, and then apply these concepts to ‘lyse’ and ‘bust’ some of the predominate prehospital myths. Find links to the primary literature on our website. We examine: 2:00 - The importance of primary literature 4:10 - Why? 10:10 – Literature, critically appraising articles, & levels of evidence 13:20 – Evidence Based Medicine 17:30 – Guidelines & Protocols 22:22 – Epinephrine in Cardiac Arrest 28:30 – Sodium Bicarbonate in Cardiac Arrest 32:10 – Advanced Airways 36:10 – “Treat the patient, not the monitor” 42:05 – TTM (Targeted Temperature Management) 48:22 – “Be Skeptical” 51:15 – TBI Management/TXA 61:05 – Final Thoughts

Paramedics receive little education on grief and bereavement. As paramedicine integrates palliative approaches to care, it has become very apparent paramedics are under-prepared for the crucial role they play in supporting patients and families in grief and recognizing and responding to their own grief reactions. In this episode we talk to Cheryl Cameron and Tyne Lunn about how paramedicine is evolving to include the provision of palliative care. We start by defining palliative care and talk about how paramedics are well positioned to support patients with palliative care needs, already seeing this patient population in our routine 911 caseload, but needs to do better to align the care we provide with people’s wishes. · MyGriefToolbox as one strategy and tool to address gaps in education/supports for paramedics · Scale and spread of this approach across Canada · Importance of person, family and caregiver centered approach · Psychosocial support, system navigation, and compassion can be provided by all levels of paramedics · De-bunking some myths about providing palliative care They’ll introduce us to MyGriefToolbox, a set of free resources that have been developed in collaboration with Canadian Virtual Hospice to support paramedics as we provide a palliative care approach and psychosocial support to grieving individuals, families, and caregivers.

On today’s episode, we carry on last month’s conversation about cardiac arrest management and care. Recorded at the Paramedicine Across Canada Expo (PACE) Conference in Saskatoon in September 2022, we’re sitting down with Mike Humphrey and Adam Perrett of Lethbridge Fire and Emergency Services to talk about how they’ve revolutionized the care provided to the citizens of Lethbridge, Alberta. We walk through how they train, evaluate, and feedback data with respect to cardiac arrests; how they use a culture of excellence to deliver high performance CPR leading to improved ROSC rates; and they use real time data to track opiate overdoses in their community.

On today's episode, we chat with Dr. Sheldon Cheskes, principal investigator of the landmark DOSE VF trial. In this study, published in the New England Journal of Medicine, Dr. Cheskes and his team wanted to evaluate DSED and VC defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest. In this episode, we walk through the study design, methodology, results, and perhaps most importantly, critically appraise the study to see how it works in the real world! Timestamps: 02:48: Dr. Cheskes Intro 06:15: Study Intro 16:45: Patients 18:18: Intervention – Vector Change 25:45: Intervention – DSED 37:12: Comparison/Outcome 40:23: Results 54:15: Critical Appraisal

Pain is a condition that we often see in the prehospital world, yet for a variety of reasons, we're bad at treating it. On today's episode with pain expert Dr. Samina Ali, we go through what pain is, pain assessment, barriers to providing analgesia, and then discuss how we actually treat pain, using both non-pharmacologic and pharmacologic interventions

Join us this month as we chat with Dr. Simon Hatcher, psychiatrist at the Ottawa Hospital and Ottawa Inner City Health, about First Responder Mental Health Who gets PTSD, what’s the pathway/differences to mental health professionals, how do we heal, and how do we get people back to work are all topics we cover, plus more!

IVEGOTYOURBACK911 was started by paramedics Jill Foster & Shaun Taylor in 2014. The goal of the campaign is to spread social awareness worldwide in regards to First Responder mental health issues. On this month’s episode of Critical Levels, we sit down with Jill & Shaun to learn a little bit more about how and why they started the company, and some of the amazing work that they’re doing to help first responders.

On today’s episode, we chat with Dr. Brodie Nolan, an emergency physician and trauma team leader at St. Michael's Hospital (one of Canada’s largest trauma centres), and a transport medicine physician for ORNGE. We discuss what trauma is, and how we define hemorrhagic shock. We discuss that trauma triad of death, and why it’s important to get these patients to a lead trauma centre. These patients ultimately need blood products, so Dr. Nolan walks us through blood/fluid resuscitation, as well as the massive hemorrhage protocol. Lastly, we cover the prehospital care of these patients: the field trauma triage and air ambulance utilization standards; A-B-Cs (the importance of de-prioritizing intubation and allowing for permissive HYPOtension); the on-scene interventions we should and shouldn’t perform; and what the future looks like for the care of these patients

On today’s episode we sit down with Dr. Sonny Dhanani, Chief of the Pediatric Intensive Care Unit (PICU) at the Children’s Hospital of Eastern Ontario (CHEO). We discuss the approach and management of the critically ill child, with an in-depth discussion on the A-B-Cs. With respect to airway, we chat tips/tricks for airway management, as well as intubation. On the topic of breathing, we chat about bagging and some of the physiological cardio-respiratory concerns of our efforts. We also discuss the causes of arrest and how our interventions may have a role. Lastly, with respect to the sick child, we cover circulation. Fluid resuscitation (physiology/type/volume/medical vs. trauma), IOs, the symptomatic bradycardic patient(pacing, pressors/medications, etc.), and shock are all topics on the table. From here, we pivot to how death is determined, and how organ donation works.

The United Nations (UN) defines human trafficking (HT) as “the recruitment, transport, transfer, harbouring, or receipt of a person by such means as threat or use of force or other forms of coercion, abduction, fraud, or deception for the purpose of exploitation“. What is human trafficking? How prevalent is it? What are the red flags? How can I use the history and assessment to raise my index of suspicion? How do I advocate for my patient? Join our conversation with Dr. Lindsay Cheskes, EM Resident at The Ottawa Hospital, to learn the answers to these questions, and more! Human trafficking: what do paramedics need to know?

After the War in Afghanistan, the Chief of Defence Staff of the Canadian Armed Forces decided to create a brand new forward aeromedical evacuation capability. This is where our episode’s guest comes in. We speak with Dr. Leilani Doyle, Lt. Col. with the Canadian Armed Forces about her role in the creation of CMERT - the Canadian Medical Emergency Response Team. Not only are we going to cover the development, roles, training, and capabilities of the team, we’re also going to discuss how to optimize battlefield medicine, and the challenges of providing high quality medical care from the resus bay in the back of the helicopter to the most austere military environments. Lastly, we cover how the work being done in the military is impacting civilian prehospital care (e.g blood, TXA, invasive procedures, etc.).

Not all paramedics respond to just 911 calls. On today’s episode, we’re chatting with Matt Cruchet and Sgt. Gregory Hudson Matt is a key member of the Country of Renfrew Paramedic Service’s Sierra Team – essentially their special operations arm. Sgt. Hudson is a Search and Rescue Technician (SAR Tech) with the 424 Transport and Rescue Squadron based out of CFB Trenton. Covering more than 10 million sq km, the 424 Transport and Rescue Squadron has a huge responsibility for maritime and aeronautical SAR We hear about their own unique prehospital roles and responsibilities, then tie it all together using a real case study.